Reproductive, Perinatal, and Pediatric Epidemiology Research

Overview

The health concerns faced in the field of reproductive, perinatal, and pediatric health are among the most pressing issues of our time, both from scientific and public perspectives. The reproductive, perinatal, and pediatric epidemiology (RPPE ) program area provides students with a multidisciplinary perspective, a strong foundation in epidemiologic concepts and methods, and an understanding of the underlying biology of reproduction and childhood development and growth. The program prepares students to pursue careers in reproductive, perinatal and pediatric epidemiologic research.

Students in the program will gain an understanding of the following items

Basic human reproduction and child development biology

Clinical and health service aspects of reproductive and perinatal health

Social, lifestyle and environmental influences on reproductive and child health

Issues in measuring and interpreting studies on fertility, pregnancy and child health

Additional Information

The health concerns faced in the field of reproductive, perinatal, and pediatric health are among the most pressing issues of our time, both from scientific and public perspectives. The ability to successfully reproduce and have a healthy child transcends other health concerns by touching on very basic human needs and desires. Whether the challenge is to understand and remedy causes of infertility, prevent prematurity or birth defects, or identify the causes of such highly visible, troubling disorders as autism or attention deficit disorder, epidemiologists have a central role that is just now being fully appreciated.

The University of North Carolina at Chapel Hill is a leader in the field of reproductive, perinatal and pediatric epidemiology. The academic departments of Epidemiology, Maternal and Child Health, Nutrition, Pediatrics, and Obstetrics and Gynecology have engaged in a variety of collaborative and individual projects to address substantive and methodological issues facing our field.

The Diet, Weight Change and Obesity During Pregnancy Study (DWOP) (Siega-Riz AM, Faith M, Burger K, Stuebe A, Nicholson W, Dorman K-NICHD, 10/13-9/18). This team of UNC investigators along with Drs. Tonja Nansel and Leaha Lipksy from NICHD and Dr. Franca Barton from EMMES Corporation will be recruiting a total of 345 women from the UNC prenatal clinics from three weight status groups (normal, over and obese) to examine the role of food reward responsivity, food reward value, and behavioral control in weight change and dietary intake during pregnancy and postpartum. Women will be followed throughout pregnancy until 1 year postpartum with protocols that include the collection of blood, stool, and urine specimens, previous and current medical information, dietary intake and eating behaviors, anthropometrics, and demographic information. Sub-studies will include: (1) a focus group study examining pregnant women’s perceptions of hedonic eating ‘triggers,’ food cravings/aversions, and food choice and alternatives, (2) a laboratory-based behavioral experiment using an innovative ‘eating in the absence of hunger’ protocol and (3) a functional magnetic resonance imaging (fMRI) of women during the postpartum period in order to obtain objective measures of food reinforcement value and food reward responsivity.
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The Pregnancy, Infection, and Nutrition Study (PIN) (Dole N, Evenson K, Herring A, Olshan A, Siega-Riz AM, Thorp J – NIH, 8/95-12/05). This team of investigators has collaborated on the decade-long PIN study to investigate the epidemiology of preterm birth, one of the major contributors to perinatal morbidity and mortality in the United States. This study’s primary goal is to identify etiologic factors for preterm delivery, including preterm premature rupture of the membranes (PROM), delivery due to early onset of labor, and related complications of pregnancy, so that public health measures can be taken to reduce this adverse pregnancy outcome and its associated health, social, and economic costs. The PIN study successfully recruited over 5000 pregnant women from central North Carolina to address physical activity, psychosocial factors, placental characteristics, postpartum weight retention, nutritional factors and food security, bacterial vaginosis and other genital tract infections, occupational physical exertion, smoking, sexual behavior during pregnancy, vaginal bleeding, genetic factors, as well as variety of health and social behaviors and community level factors.
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The PIN Postpartum Study (Siega-Riz AM, Evenson K, Herring A, Dole N, Moos M-K, Thorp J, NIH, 8/02-7/07) was added as a major extension of the PIN study in 2002. This study follows women (n=689) for the first year post-partum to identify modifiable factors related to postpartum weight retention and postpartum mental health. The study collects data in the home 3 and 12 months after delivery including: maternal height, weight, and percent body fat using bioelectrical impedance, and an interview about diet, breastfeeding status, body image, behaviors, health and work status, physical activity, and psychosocial factors.. Focus groups during pregnancy and in-depth interviews during the postpartum period were conducted among a subset of women to collect qualitative information on barriers and enhancements to physical activity, healthy eating, and weight loss during the postpartum period. Dr. Siega-Riz collaborated with Dr. Evenson, who received funding to add a detailed assessment of physical activity and neighborhood factors to this, and Dr. Daniels, received funding to follow the growth and neurodevelopment of the infants.
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North Carolina Center for Birth Defects Research and Prevention (Olshan A, Siega-Riz A, Herring A, Meyer R, CDC, 9/02-8/13). The North Carolina Center for Birth Defects Research and Prevention conducts surveillance and collaborates with Centers across the country to conduct case-control studies of risk factors for birth defects (the National Birth Defects Prevention Study). The national study now includes over 14,000 cases of birth defects and 8,000 controls. The Center is a close collaboration with the North Carolina Department of Public Health. Telephone interviews are conducted and DNA is collected by buccal cells to allow detailed evaluation of environmental, nutritional, and genetic factors that might be associated with specific birth defects. Dr. Olshan is currently evaluating trends in neural tube defects and other folic acid preventable birth defects following folic acid interventions, as well as inflammation, metabolizing enzyme, and DNA repair gene polymorphisms that may be associated with oral clefts, neural tube, and heart defects. Dr. Siega-Riz, a Center investigator, has begun evaluating nutritional factors associated with various birth defects such as gastroschisis, NTD’s, etc. Dr. Daniels mentored Cynthia Cassell, an MCH doctoral student with a minor in Epidemiology, who linked North Carolina Center for Birth Defects Research and Prevention data to state Medicaid data to conduct her dissertation research on the cost and services used by children with oral facial clefts.
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Maternal Smoking, Maternal and Fetal Genetic Variation, and Risk of Preeclampsia R01HD058008. NICHD 06/01/2008 – 05/31/2013 (Engel PI) The goal of this project is to elucidate the influence of genetic variation in candidate genetic pathways on the development of preeclampsia among smokers and non-smokers. This study is nested within the Norwegian Mother and Child Birth Cohort (MoBa). All cases of preeclampsia in MoBa were validated by independent record review. We will select 750 cases of preeclampsia and 750 validated non-cases for genotyping. Maternal and fetal DNA will be assayed using the Affymetrics Whole Exome genoytyping array, which includes 300,000 coding SNPs including non-synonymous and synonymous SNPs as well as variants in splice and stop codons, and approximately 30,000 SNP and complex indels from draft 1 of the thousand genomes project. Additionally, a supplement of 100,000 promoter/enhancer site variants across genes in high priority pathways (inflammation, apoptosis, angiogenesis, smoking detoxification and carbon monoxide signaling) will be added.
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A Pooled Investigation of Prenatal Phthalate Exposure and Childhood Obesity. R21ES021700 NIEHS 07/01/2012 – 06/31/2014 (Engel PI). Starting in 1998, NIEHS and EPA jointly funded a network of Children’s Environmental Health and Disease Prevention Research Centers, with the mission of addressing the role of environment in children’s health. The Mount Sinai, Columbia, and Cincinnati Children’s Centers each enrolled independent prospective birth cohorts, collected third trimester urine specimens, and followed children up for growth and development. Each of these Centers has already measured maternal urinary phthalate metabolites in the third trimester. We propose to pool these data in order to efficiently examine the association between maternal phthalate concentrations and longitudinal measures of adiposity from birth through age 7 years. To our knowledge, these three birth cohorts together represent the only US studies with currently available data on phthalates and growth through age 7, and constitute a rich and unique resource to efficiently address the aims of this study while providing the foundation for future pooling efforts to address the impact of environmental chemicals on children’s health.
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Malaria and HIV in Pregnant Women in Malawi (Meshnick S NIH 8/1/12 – 07/31/14)
Genetic epidemiology of malaria in the Democratic Republic of the Congo
Malaria is very highly endemic in the Democratic Republic of the Congo (DRC). We propose to use >16,000 dried blood spots from the 2007 and 2012 Demographic and Health Surveys (DHS) in the DRC to conduct the first longitudinal, nation-wide study of malaria genetic epidemiology. Our aim is to determine the effects of malaria control efforts on the prevalence of P. falciparum and other malaria species.
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Pediatric Health

The North Carolina Center for Autism and Developmental Disabilities Epidemiology ( U50/CCU422345-04 & U10DD000184-01 – CDC 09/30/2006 – 06/29/2016 (Daniels JL, PI).
NC was one of six sites in a multi-site case-control study investigating genetic and environmental causes of autism, as well as phenotypic and behavioral correlates of autism and development. The first phase of the study has just ended, yielding rich biologic, genetic, health, and developmental data on approximately 700 children with autism, 700 children with other disabilities, and 700 sampled from the community and their families. The second phase of the study maintains a similar protocol and enters the field this spring (May, 2012) – which will essentially double the sample size. This project is among the largest epidemiologic studies of risk factors for autism and developmental disabilities to date. The second phase of the study offers students opportunities to gain experience in field data collection and the administrative aspects of multi-site studies; while the first phase of the study is primed for epidemiologic investigation and analysis. Students can generate and investigate hypotheses that will benefit from the rigorously collected data on an extensive array of genetic and environmental risk factors. The reputable multi-site investigator group is collaborative and engaging, providing students with professional entrée into the growing field of autism epidemiology
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Assessment of Perinatal PBDE Exposure and related Child Behavioral and Cognitive Developmental Effects (Daniels J, EPA, 3/06-3/09). The primary aim of the study was to investigate children s exposure to PBDEs through breast milk, diet and their physical environment in relation to cognitive and behavioral development. This study followed a subcohort of the children born to participants of the PIN studies until they were 3 years of age. Home visits were conducted at 3, 12 and 36 months to investigate a variety of environmental exposures that may affect their health, including PBDEs, diet, and social factors, and assess the child s general health, neurodevelopment, and anthropometry. Participants of this study are children born to participants of two existing studies: the Pregnancy, Infection, and Nutrition (PIN) Study follows women through the end of pregnancy, then the PIN Postpartum Study continues to follow them through the first year postpartum. Linkage with these studies provides considerable information on the mothers during pregnancy, including diet, stress, psychosocial health, infection, weight status, physical activity, and blood samples. This study will offer students many opportunities to evaluate exposures during pregnancy and early life in relation to children’s health.
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Genetic Susceptibility Factors in the Etiology of Neuroblastoma (Olshan A, Siega-Riz AM, NIH 08/01/08 – 07/30/13). Over a five-year period, the Neuroblastoma Epidemiology in North America (NENA) study seeks to enroll approximately 600 children (living and deceased) who were diagnosed with neuroblastoma before 6 years of age. In addition, NENA is enrolling the biological mothers and biological fathers of these children. In this way, biological triads can be studied which allows NENA to explore the genetics of the disease. Children with neuroblastoma, along with their biological parents, are recruited from the US, Puerto Rico and Canada to participate in this research.
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Hispanic Community Children’s Health Study of Latino Youth- Coordinating Center RO1-HL1021301 4/1/2011-11/30/2014 (Bangdiwala, S PI, co-investigator Siega-Riz) US Latino youth are more overweight or obese than non-Hispanic white youth and are at risk for lasting cardiovascular complications into adulthood. The present study will study a wide range of cultural factors (e.g., family environment, physical, social) associated with obesity in a sample of 1,600 Latino boys and girls aged 8-14 years old from the Bronx, NY; Chicago, IL; Miami, FL and San Diego, CA. Findings from our study will inform practice and policy efforts to develop programs to prevent obesity in Latino youth and thus improve the health of future generations.
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Why I chose UNC:
I received my MPH here from UNC, so I was already aware of the phenomenal faculty, students, and resources that the Gillings School of Global Public Health had to offer. The UNC Epidemiology department is also known for the rigor of their methods training, an area which I wanted to pursue more.

Alan Kinlaw
4th year MSPH/PhD student in the Department of Epidemiology

Prior degrees:

BS, Textile Engineering (Biomedical Materials), North Carolina State University

BA, French Language and Literature, North Carolina State University

Research interests include:

Perinatal nutrition

Environmental exposures

Child developmental outcomes

Pharmacoepidemiology

Epidemiologic methods

Health disparities

Why I chose UNC:
I chose UNC because of the large and diverse network of accessible faculty and students in our department. Their constant collaboration with scholars in epidemiology and related fields promotes a positive environment for research, teaching and learning.

Suzanne Landi
2nd year PhD Student in the Department of Epidemiology

Prior degrees:

MPH, Epidemiology (George Mason University)

BA, Linguistics (Bryn Mawr College)

Research interests include:

Pregnancy outcomes

Fertility

Hormonal contraceptives/family planning

Pharmacoepidemiology

Epidemiologic methods

Why I chose UNC:
I knew I wanted to gain skills in epidemiologic methods, and the UNC Department of Epidemiology is a fantastic place for that kind of training. The faculty and students are working at the cutting edge of methods, and are a great resource for teaching and mentorship. I also desired opportunities to work with other topic areas and departments in the School of Global Public Health, which is highly encouraged here.

Chantel Martin
6th year PhD Student in the Department of Epidemiology

Prior degrees:

MSPH, UNC Charlotte

BA, Finance (Minor in Economics), University of Delaware

Research interests include:

Maternal nutrition

Social and environmental factors

Pregnancy outcomes

Child weight status

Obesity trends

Epidemiologic methods

Why I chose UNC:
UNC has a strong research and faculty base, with many ongoing research projects on the cutting-edge. Students have lots of opportunities to engage in research activities to bridge their educational and research training.

Nelson Pace
2nd year PhD Student in the Department of Epidemiology

Prior degrees:

SM, Epidemiology, Harvard University

BS, Statistics, Brigham Young University

Research interests include:

Maternal nutrition

Environmental exposures (air pollution, herbicide use)

Birth Defects

Vaccine use during pregnancy

Causal Inference

Why I chose UNC:
UNC offers an incredible number of opportunities to be at the forefront of cutting-edge research. Faculty are very supportive of student-initiated research projects and help students make the right connections to pursue scientific questions. Coming to the Gillings School of Global Public Health gave me a chance to work with outstanding faculty that had very similar research interests as myself particularly in the area of reproductive and perinatal epidemiology. I also feel that UNC greatly values their students and their contribution to the university.

The RPPE program area provides students with a multidisciplinary perspective, a strong foundation in epidemiologic concepts and methods, and an understanding of the underlying biology of reproduction and childhood development and growth. The program prepares students to pursue careers in reproductive, perinatal and pediatric epidemiologic research.

Through their participation in the program, students gain an understanding of the following:

basic human reproduction and child development biology

clinical and health service aspects of reproductive and perinatal health

social, lifestyle, and environmental influences on reproductive and child health

issues in measuring and interpreting studies on fertility, pregnancy, and child health

As a part of the RPPE curriculum, students perform course work in the Departments of Epidemiology, Biostatistics, Maternal and Child Health, Nutrition and Biology; attend seminars and journal clubs regarding innovative and developing research topics; and conduct research under the guidance of experienced program faculty.

The RPPE Training Grant offers 5 predoctoral positions that provide stipend, tuition remission, health insurance, and some travel costs. Interested students in the Departments of Maternal and Child Health, Nutrition, and Epidemiology are encouraged to apply. Application for Training Grant positions is competitive.

Graduate Student Research Assistantships

Research assistantships (RAs) offer students an opportunity to gain research-related experience, develop close working relationships with faculty, and sometimes earn CO-authorship on peer-reviewed publications. Information on the type of assistantships available and how to locate them is available from Student Services. A small number of RA positions are typically available in the RPPE program. Students interested in an assistantship should submit an application form (available from Student Services), and should discuss this interest with their advisors.

External funding

Some students in the RPPE program have secured funding through sources that are external to the Department or the University. Please click on the links below for further information about some of these external funding sources.